on Exercise Physical Activity for Individuals with Type 2 Diabetes Purpose of the Update This statement is an update of the 2010 position stand on exercise amp type 2 diabetes T2D published jointly by the American College of Sports Medicine ACSM and the American Diabetes Association ADA ID: 1033074
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1. ACSM Expert Consensus Statement on Exercise / Physical Activity for Individuals with Type 2 Diabetes
2. Purpose of the UpdateThis statement is an update of the 2010 position stand on exercise & type 2 diabetes (T2D) published jointly by the American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA).1A substantial amount of research on T2D has been published in the last decade with a large focus on the effects of exercise on individuals with T2D.This consensus provides a brief summary of the current evidence along with extensions and updates of the prior recommendations.
3. IntroductionDiabetes affects over 463 million people worldwide2 with a prevalence in the United States of 10.5%.3T2D accounts for 90-95% of all cases.4Treatment goals for T2D are to facilitate an individualized treatment plan, including:EducationGlycemic management Reduction of cardiovascular disease (CVD) riskOngoing screening for microvascular complications
4. IntroductionLifestyle interventions and medication are usually prescribed for treatment of T2D. More recently, bariatric surgery has also become part of a possible treatment plan. Multiple types of physical activity (PA) enhance health and glycemic management in people with T2D.Many of the benefits from PA result from improved insulin sensitivity and body composition, along with CVD risk reductions.
5. IntroductionThe current authors used a consensus approach to synthesize available evidence from clinical trials, case reports, narrative and systematic reviews, and meta-analyses.The recommendations represent the consensus of the writing panel and ACSM and incorporate guidance from other professional organizations with expertise in this area, such as the American Diabetes Association (ADA).
6. Consensus Statements & Recommendations Physical ActivityRegular PA enhances:β-cell functionInsulin sensitivityVascular functionGut microbiotaCan lead to a greater management of diabetes, overall health, and reductions in disease risk.
7. Consensus Statements & Recommendations Aerobic ExerciseImproves glycemic management in adults with T2DLess daily time in hyperglycemia0.5-0.7% reductions in overall glycemia (measured via A1C)Additional improvements in:Insulin sensitivityBlood lipid profileBlood pressureWeight loss
8. Consensus Statements & Recommendations Resistance Exercise10-15% Improvements in:Muscular strengthSkeletal muscle massInsulin sensitivityBone mineral densityBlood pressureBlood lipid profilesHigh-intensity resistance exercise has greater beneficial effects than low-to-moderate intensity for overall glucose management and attenuation of insulin levels.
9. Consensus Statements & Recommendations High-Intensity Interval ExerciseImprovements in the following:A1CCGM-monitored glycemiaBody composition Insulin sensitivityPancreatic β-cell functionBody mass index
10. Consensus Statements & Recommendations Recommendations for Adults with T2DSmall “doses” of PA throughout the day to break up sedentary phasesAttenuates postprandial glucose and insulin levels in individuals with insulin resistance and higher BMI. Weight loss of >5% appears to be necessary for beneficial effects on A1C, blood lipids, and blood pressure. Individuals with prediabetes and low PA levels benefit from moderate-intensity walking and other exercise with minimal weight loss.Moderate- to high-intensity exercise (~500 kcal) done 4-5 d/wk reduces abdominal, but particularly visceral, fat in adults with T2D and may lower their metabolic risk
11. Consensus Statements & Recommendations Recommendations for Adults with T2DExercises that enhance joint flexibility are highly beneficial for health and well-being in older adults with T2D.Flexibility exercises, alone or in combination with resistance training, improves joint range-of-motion. Many lower body and core resistance exercises double as balance training.Balance exercises may reduce the risk of falls by improving balance and gait, even in adults with peripheral neuropathy.
12. Consensus Statements & Recommendations In youth with T2D, intensive lifestyle interventions plus metformin have not been superior to metformin alone in managing glycemia.Despite the limited data, it is still recommended that youth and adolescents with T2D meet the same physical activity goals set for youth in the general population.
13. Consensus Statements & Recommendations Pregnant women with and without diabetes should participate in at least 20-30 minutes of moderate-intensity exercise most days of the week.Individuals with T2D using insulin or insulin secretagogues may need to supplement with carbohydrates to prevent hypoglycemia around or during exercise.Participation in an exercise program prior to bariatric surgery may enhance surgical outcomes, and after surgery participation confers additional benefits.
14. ConclusionsVarious types of PA, including exercise, can greatly enhance the physical and mental health and glycemic management of individuals with T2DM.The Physical Activity Guidelines for Americans (2018) are applicable to most individuals with diabetes, including youth, with a few exceptions and modifications.All individuals should engage in regular PA, reduce sedentary behavior, and break up elongated sitting time with frequent activity sessions.
15. ConclusionsPA undertaken with health complications (including most diabetes-related ones) can be made safe and efficaciousExercise training undertaken before and after bariatric surgery is warranted and may enhance its health benefits. Barriers to, and inequities in, PA and exercise adoption and maintenance need to be addressed to maximize participation.
16. ReferencesColberg SR, Albright AL, Blissmer BJ, Braun B, Chasan-Taber L, Fernhall B, et al. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2010;42(12):2282-303. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020.American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-s33.
17. AcknowledgementsThis slide deck was prepared by the ACSM Evidence-Based Practice Committee in collaboration with the authors